Download pseudomembranous colitis due to clostridium difficile abc

JBR–BTR, 2014, 97: 158-159.
PSEUDOMEMBRANOUS COLITIS DUE TO CLOSTRIDIUM DIFFICILE
R. Kiliçarslan, H. Toprak, F. Ozturk, E. Kocakoç1
Key-word: Colitis, pseudomembranous
Background: A 25-year-old man was treated with ampicillin for acute tooth inflammation. After
five days, he presented to the emergency department with intermittent abdominal pain especially at the right lower and left upper quadrant, bloody diarrhea, fever and nausea. Physical
examination revealed diffuse abdominal tenderness, especially at right lower quadrant and right
flank, but no peritoneal signs. Laboratory studies showed an elevated white blood cell count and
metabolic acidosis.
Plain radiography of the abdomen was obtained, followed by emergency abdominal contrastenhanced CT for further evaluation.
A
B
C
1 2A
Fig.
2B2C
1. Department of Radiology, Bezmialem Vakif University, Faculty of Medicine, Istanbul,
Turkey
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PSEUDOMEMBRANOUS COLITIS — KILIçARSLAN et al
Work-up
On AP plain radiography of the abdomen (Fig. 1),
large bowel dilatation without air fluid levels and
diffuse nodular thickening with haustral ‘thumbprinting’, especially in left upper quadrant is seen.
Contrast-enhanced CT scan of the abdomen includes an axial section at the level of the upper abdomen (A), a reformatted image in the coronal
plane posteriorly in the abdomen, at the level of the
ascending and descending colon (B), and a reformatted image in the coronal plane more anteriorly
in the abdomen, at the level of the transverse colon
(C). The CT images reveal marked mural and haustral thickening, as well as a hypodense aspect of the
entire colon indicating pancolitis (arrows). The images also show stripes of contrast trapped between
nodular and thickened haustra, called ‘accordion
sign’ in literature.
Radiological diagnosis
The clinical history and imaging findings are suggestive for pseudomembranous colitis. The patient
was treated with oral vancomycin and exhibited
rapid improvement.
Discussion
Pseudomembranous colitis (PMC) is an acute infection caused by toxins produced by an unopposed proliferation of Clostridium difficile bacteria
in the colon. C. difficile infection is responsible for
virtually all cases of PMC and for up to 20% of cases
of antibiotic-associated diarrhea without colitis.
The clinical features of PMC include diarrhea,
abdominal tenderness, fever, dehydration, and
­
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159
l­eukocytosis. Occasionally, patients with C. difficile
colitis present with or progress to fulminant, lifethreatening colitis. The diagnosis of PMC depends
on the demonstration of C. difficile toxins in the
stool or of characteristic adherent yellow plaques
2–10 mm in diameter at proctosigmoidoscopy or
colonoscopy.
The treatment of PMC consists of oral administration of metronidazole or vancomycin. However,
in patients with a fulminant and toxic form of PMC
who fail to respond to medical therapy, surgical intervention can be lifesaving.
It is important for radiologists to be aware of
mortality in this life-threatening condition and its
imaging characteristics because they may be the
first to suggest the diagnosis. If not treated aggressively, pseudomembranous colitis can result in
significant morbidity and mortality. The radiologic
diagnosis of pseudomembranous colitis is important because the lack of aggressive treatment may
lead to increased morbidity.
Bibliography
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